Skip to main content
SpringerLink
Log in

Prevalence of retinopathy in patients with type 1 diabetes diagnosed before and after puberty

  • Original Article
  • Published:
Acta Diabetologica Aims and scope Submit manuscript

Abstract

Aims

There is conflicting evidence to support the concept that the years with diabetes preceding puberty may not contribute to the development of vascular complications. In this paper, duration-related prevalence of retinopathy was compared in patients who developed type 1 diabetes before and after pubertal age.

Methods

Retrospective analysis of prospectively collected data of 1,483 patients was screened for retinopathy in 1991–2010, with diabetes onset at age ≤29, who were on insulin treatment and aged ≤60. Prepubertal age was defined as 0–12 in males and 0–11 in females.

Results

A total of 647 patients had developed diabetes before and 836 after puberty. Cumulative prevalence of retinopathy was initially lower among those with prepubertal onset diabetes but rates became superimposable after 20-year duration. Patients with prepubertal onset diabetes had higher lifetime HbA1c and lower blood pressure than those who became diabetic after puberty.

Conclusions/interpretation

Retinopathy is infrequent during childhood and develops later than in patients with post-pubertal onset diabetes. After 20-year duration, however, retinopathy becomes just as prevalent suggesting that, in the long term, prepubertal years do contribute to the development of retinopathy. In this series, higher blood pressure may have played a role in the earlier appearance of retinopathy in patients with diabetes onset after puberty, whereas worse metabolic control may have contributed to the late “catch-up” effect in those with prepubertal onset disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Antonetti DA, Klein R, Gardner TW (2012) Diabetic retinopathy. N Engl J Med 366:1227–1239

    Article  CAS  PubMed  Google Scholar 

  2. Porta M, Bandello F (2002) Diabetic retinopathy. A clinical update. Diabetologia 45:1617–1634

    Article  CAS  PubMed  Google Scholar 

  3. Kostraba JN, Dorman JS, Orchard TJ et al (1989) Contribution of diabetes duration before puberty to the development of microvascular complications in IDDM subjects. Diabetes Care 12:686–693

    Article  CAS  PubMed  Google Scholar 

  4. Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL (1985) Retinopathy in young-onset diabetic patients. Diabetes Care 8:311–315

    Article  CAS  PubMed  Google Scholar 

  5. Kullberg CE, Abrahamsson M, Arnqvist HJ, Finnstrom K, Ludvisson J (2002) Prevalence of retinopathy differs with age at onset of diabetes in a population of patients with type 1 diabetes. Diabet Med 19:924–931

    Article  CAS  PubMed  Google Scholar 

  6. Palmberg P, Smith M, Waltman S et al (1981) The natural history of retinopathy in insulin-dependent juvenile-onset diabetes. Ophthalmology 88:613–618

    Article  CAS  PubMed  Google Scholar 

  7. Frank RN, Hoffman WH, Podgor MJ (1981) Retinopathy in juvenile-onset diabetes of short duration. Ophthalmology 87:1–9

    Article  Google Scholar 

  8. Kalter-Leibovici O, Leibovici L, Loya N, Kremer I, Axel-Siegel R, Karp M, Laron Z (1997) The development and progression of diabetic retinopathy in type I diabetic patients: a cohort study. Diabet Med 14:858–866

    Article  CAS  PubMed  Google Scholar 

  9. Donague KC, King J, Fung ATW et al (1997) The effect of prepubertal diabetes duration on diabetes microvascular complications in early and late adolescence. Diabetes Care 20:77–80

    Article  Google Scholar 

  10. Lobefalo L, Verrotti A, Della Loggia G, Morgese G, Mastropasqua L, Chiarelli F, Gallenga PE (1997) Diabetic retinopathy in childhood and adolescence. Effect of puberty. Diabetes Nutr Metab 10:193–197

    Google Scholar 

  11. Sivieri R, Rovera A, Porta M (1995) SEE (save eyes in Europe): the London protocol in software. G Ital Diabetol 15(Suppl.):37–38

    Google Scholar 

  12. Retinopathy Working Party (1991) A protocol for screening for diabetic retinopathy in Europe. Diabet Med 8:263–267

    Article  Google Scholar 

  13. Porta M, Maurino M, Severini S et al (2013) Clinical characteristics influence screening intervals for diabetic retinopathy. Diabetologia 56:2147–2152

    Article  PubMed  Google Scholar 

  14. Porta M, Dalmasso P, Grassi G, Marena S, Maurino M, Passera P, Trento M (2004) Pre-pubertal onset of type 1 diabetes and appearance of retinopathy. Diabetes Metab 30:229–233

    Article  CAS  PubMed  Google Scholar 

  15. Porta M, Sjoelie A-K, Chaturvedi N, Stevens L, Rottiers R, Veglio M, Fuller JH, The EURODIAB Prospective Complications Study Group (2001) Risk factors for progression to proliferative diabetic retinopathy in the EURODIAB prospective complications study. Diabetologia 44:2203–2209

    Article  CAS  PubMed  Google Scholar 

  16. Salardi S, Porta M, Maltoni G et al (2012) Infant and toddler type 1 diabetes mellitus: complications after 20 years’ duration. Diabetes Care 35:829–833

    Article  PubMed Central  PubMed  Google Scholar 

  17. Barnes HV (1976) Physical growth and development during puberty. Med Clin North Am 59:1305–1317

    Google Scholar 

  18. Kernell A, Dedorsson I, Johansson B, Wickstrom CP, Ludvigsson J, Tuvemo T, Neiderud J (1997) Prevalence of diabetic retinopathy in children and adolescents with IDDM. Diabetologia 40:307–310

    Article  CAS  PubMed  Google Scholar 

  19. Murphy RP, Wanda M, Plonick L, Enger C, Vitale S, Patz A (1990) The relationship of puberty to diabetic retinopathy. Arch Ophthalmol 108:215–218

    Article  CAS  PubMed  Google Scholar 

  20. Trento M, Passera P, Trevisan M et al (2013) Quality of life, impaired vision and social role in people with diabetes: a multicenter observational study. Acta Diabetol 50:873–877

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by a generous grant to the Centro Retinopatia Diabetica from the Compagnia di San Paolo, Turin, and by research grants from the University of Turin and the Italian Ministry of Health (Fondi “ex-60 %”).

Conflict of interest

Massimo Porta, Francesca Schellino, Marcello Montanaro, Anatolie Baltatescu, Lorenzo Borio, Tatiana Lopatina, Marina Trento, Paola Dalmasso and Franco Cavallo declare that they have no conflict of interest.

Human and animal rights disclosure

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Declaration of Helsinki 1975, as revised in 2008.

Informed consent disclosure

Informed consent was obtained from all patients for being included in the study.

Author information

Authors and Affiliations

  1. Department of Public Health and Paediatric Sciences, University of Turin, Via Santena, I-10126, Turin, Italy

    Paola Dalmasso & Franco Cavallo

  2. Diabetic Retinopathy Centre, Department of Medical Sciences, University of Turin, Corso AM Dogliotti 14, I-10126, Turin, Italy

    Massimo Porta, Francesca Schellino, Marcello Montanaro, Anatolie Baltatescu, Lorenzo Borio, Tatiana Lopatina & Marina Trento

Authors
  1. Massimo Porta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesca Schellino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marcello Montanaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anatolie Baltatescu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lorenzo Borio
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tatiana Lopatina
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marina Trento
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Paola Dalmasso
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Franco Cavallo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Massimo Porta.

Additional information

Managed by Massimo Federici.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Porta, M., Schellino, F., Montanaro, M. et al. Prevalence of retinopathy in patients with type 1 diabetes diagnosed before and after puberty. Acta Diabetol 51, 1049–1054 (2014). https://doi.org/10.1007/s00592-014-0671-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00592-014-0671-2

Keywords

Search

Navigation